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Cognitive Function After Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrest in Management of Renal Cell Carcinoma With Vena Caval Thrombus

  • Author Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Xingyun Cai
    Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Author Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Jiwei Huang
    Correspondence
    Address correspondence to: Jiwei Huang, M.D., Yonghui Chen, M.D. and Wei Xue, PhD, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.1630 Dongfang Road, Pudong New Area, Shanghai, China, 200127.
    Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Xiaoying Yao
    Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Affiliations
    Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Author Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Hongyang Qian
    Footnotes
    † These authors have contributed equally to this work and share first authorship.
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Jin Zhang
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Wen Kong
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Xiaorong Wu
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Yiran Huang
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Yonghui Chen
    Correspondence
    Address correspondence to: Jiwei Huang, M.D., Yonghui Chen, M.D. and Wei Xue, PhD, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.1630 Dongfang Road, Pudong New Area, Shanghai, China, 200127.
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
    Search for articles by this author
  • Wei Xue
    Correspondence
    Address correspondence to: Jiwei Huang, M.D., Yonghui Chen, M.D. and Wei Xue, PhD, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.1630 Dongfang Road, Pudong New Area, Shanghai, China, 200127.
    Affiliations
    Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    † These authors have contributed equally to this work and share first authorship.

      Abstract

      Objective

      To compare cognitive outcomes of patients undergoing open radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy with vs without cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest.

      Patients and Methods

      A prospective, 6-month, observational study was conducted from January 2013 to December 2019 in renal cell carcinoma patients with level II-IV IVC thrombus undergoing RN. A battery of standardized neuropsychological tests was administrated to assess multi-domain cognitive function before surgery, 1 week, and 6 months after surgery: attention, executive functions, working memory, short-term and long-term delay recall, visuomotor speed, and verbal fluency.

      Results

      Cognitive impairment was defined as a 20% reduction in at least 20% of the main variables. The primary outcome was the incidence of cognitive impairment at 6 months postoperatively and was analyzed with general linear mixed models. Twenty-six patients treated with CPB and 39 treated with non-CPB were analyzed. There were no significant differences in cognitive impairment between the two groups. The incidence of cognitive impairment at 1 week postoperatively was 38.5% in CPB group and 30.8% in non-CPB group (P = .52), after 6 months 11.5% and 10.3% (P = 1.00). Multivariate analysis indicated that the estimated blood loss was the only risk factor associated with cognitive impairment at 1 week postoperatively.

      Conclusion

      This study showed no significant differences in postoperative cognitive function of renal cell carcinoma patients after open RN and IVC thrombectomy with and without CPB and deep hypothermic circulatory arrest. Estimated blood loss was found to be associated with cognitive impairment at 6 months postoperatively.
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      References

        • Marshall F.F.
        • Dietrick D.D.
        • Baumgartner W.A.
        • Reitz B.A.
        Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins.
        J Urol. 1988; 139: 1166-1172
        • Margulis V.
        • Master V.A.
        • Cost N.G.
        • et al.
        International consultation on urologic diseases and the European Association of Urology international consultation on locally advanced renal cell carcinoma.
        Eur Urol. 2011; 60: 673-683
        • Haddad A.Q.
        • Wood C.G.
        • Abel E.J.
        • et al.
        Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort.
        J Urol. 2014; 192: 1050-1056
        • Blute M.L.
        • Leibovich B.C.
        • Lohse C.M.
        • Cheville J.C.
        • Zincke H.
        The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus.
        BJU Int. 2004; 94: 33-41
        • Ciancio G.
        • Gonzalez J.
        • Shirodkar S.P.
        • Angulo J.C.
        • Soloway M.S.
        Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description.
        Eur Urol. 2011; 59: 401-406
        • Welz A.
        • Schmeller N.
        • Schmitz C.
        • et al.
        Resection of hypernephromas with vena caval or right atrial tumor extension using extracorporeal circulation and deep hypothermic circulatory arrest: a multidisciplinary approach.
        Eur J Cardiothorac Surg. 1997; 12: 127-132
        • Chen Y.H.
        • Wu X.R.
        • Hu Z.L.
        • et al.
        Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest.
        World J Surg Oncol. 2015; 13: 159-163
        • Vaidya A.
        • Ciancio G.
        • Soloway M
        Surgical techniques for treating a renal neoplasm invading the inferior vena cava.
        J Urol. 2003; 169: 435-444
        • Cockrell J.R.
        • Folstein M.F..
        Mini-Mental State Examination (MMSE).
        Psychopharmacol Bull. 1988; 24: 689-692
        • Wen H.B.
        • Zhang Z.X.
        • Niu F.S.
        • Li L..
        The application of Montreal cognitive assessment in urban Chinese residents of Beijing.
        Chin J Int Med. 2008; 47: 36-39
        • Hamilton M..
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Guo Q.H.
        • Sun Y.M.
        • Yu P.M.
        • et al.
        Norms for auditory verbal learning test in the normal aged in Chinese community.
        Chin J Clin Psychol. 2007; 15: 132-135
        • Monaco M.
        • Costa A.
        • Caltagirone C.
        • Carlesimo G.A.
        Forward and backward span for verbal and visuo-spatial data: standardization and normative data from an Italian adult population.
        Neurol Sci. 2013; 34: 749-754
        • Guo Q.H.
        • Sun Y.M.
        • Yuan J.
        • et al.
        Application of eight executive tests in participants at Shanghai communities.
        Chin J Behav Med Sci. 2007; 16: 628-631
        • Lezak M.D.
        • Howieson D.B.
        • Loring D.W.
        • et al.
        Neuropsychological assessment. ed. 2.
        J Neurol Neurosurg Psychiatry. 2004; 62: 1237
        • Sun Y.M.
        • Guo Q.H.
        • Yuan J.
        • et al.
        The norms and the cut off scores of four fluency tests in the middle aged and the old in Shanghai communities.
        Chin J Behav Med Sci. 2007; 16: 714-717
        • Mahanna E.P.
        • Blumenthal J.A.
        • White W.D.
        • et al.
        Defining neuropsychological dysfunction after coronary artery bypass grafting.
        Ann Thorac Surg. 1996; 61: 1342-1347
        • Evered L.A.
        • Silbert B.S..
        Postoperative cognitive dysfunction and noncardiac surgery.
        Anesth Analg. 2018; 127: 496-505
        • Stroobant N.
        • Van Nooten G.
        • Van Belleghem Y.
        • et al.
        Relation between neurocognitive impairment, embolic load, and cerebrovascular reactivity following on- and off-pump coronary artery bypass grafting.
        Chest. 2005; 127: 1967-1976
        • Ciancio G.
        • Manoharan M.
        • Katkoori D.D.
        • et al.
        Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience.
        Eur Urol. 2010; 57: 667-672
        • Van Dijk D.
        • Spoor M.
        • Hijman R.
        • et al.
        Cognitive and cardiac outcomes 5 years after off-pump versus on-pump coronary artery bypass graft surgery.
        JAMA. 2007; 297: 701-708
        • Habibi V.
        • Habibi M.R.
        • Habibi A.
        • et al.
        The protective effect of hypothermia on postoperative cognitive deficit may be attenuated by prolonged coronary artery bypass time: Meta-analysis and meta-regression.
        Adv Clin Exp Med. 2020; 29: 1211-1219
        • Nguyen H.G.
        • Tilki D.
        • Dall'Era M.A.
        • et al.
        Cardiopulmonary bypass has no significant impact on survival in patients undergoing nephrectomy and level III-IV inferior vena cava thrombectomy: multi-institutional analysis.
        J Urol. 2015; 194: 304-308
        • Shuch B.
        • Crispen P.L.
        • Leibovich B.C.
        • et al.
        Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?.
        BJU Int. 2011; 107: 724-728
        • Brown W.
        • Moody D.
        • Challa V.
        • Stump D.A.
        • Hammon J.W..
        Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli.
        Stroke. 2000; 31: 707-713
        • Monk T.G.
        • Weldon B.C.
        • Garvan C.W.
        • et al.
        Predictors of cognitive dysfunction after major noncardiac surgery.
        Anesthesiology. 2008; 108: 18-30
        • Van Dijk D.
        • Spoor M.
        • Hijman R.
        • et al.
        Cognitive and cardiac outcomes 5 years after off-pump versus on-pump coronary artery bypass graft surgery.
        JAMA. 2007; 297: 701-708
        • Daiello L.A.
        • Racine A.M.
        • Yun Gou R.
        Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence.
        Anesthesiology. 2019; 131: 477-491
        • Evered L.A.
        • Silbert B.S..
        Postoperative cognitive dysfunction and noncardiac surgery.
        Anesth Analg. 2018; 127: 496-505
        • Howieson D.
        Current limitations of neuropsychological tests and assessment procedures.
        Clin Neuropsychol. 2019; 33: 200-208